Provider Demographics
NPI:1003221565
Name:ESTRADA, JESSICA (RECOVERY WORKER)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:RECOVERY WORKER
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RECOVERY WORKER
Mailing Address - Street 1:2275 EAST COOLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324
Mailing Address - Country:US
Mailing Address - Phone:909-370-1777
Mailing Address - Fax:909-370-1776
Practice Address - Street 1:2275 E COOLEY DR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-6324
Practice Address - Country:US
Practice Address - Phone:909-370-1777
Practice Address - Fax:909-370-1776
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)